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02/25/2004 12:15 FAX 14024714429 NEBRASKA UCC 191003 /005 <br />J <br />If <br />NOTICE OF STATE TAX LIEN <br />This Notice of State Tax Lien is issued by the Nebraska - Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />In the county for real and personal property belonging to the taxpayer <br />or hereafter ac uired. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />200401663 <br />Nebraska Identification Number <br />Please rewm to: <br />Lien Filed With <br />-STATE OF NEBRASKA <br />Social Security Number <br />DEPARTMENT OF REVENUE <br />41980999 <br />1811 WEST 2ND ST STE 460 <br />❑X Register of Deeds <br />GRAND ISLAND NE 68803 <br />It <br />Amount of Tax <br />Lien Serial Number <br />Interest <br />Lien Type <br />Balance of <br />Date of Lien <br />County <br />032270888 <br />NOTICE OF STATE TAX LIEN <br />This Notice of State Tax Lien is issued by the Nebraska - Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />In the county for real and personal property belonging to the taxpayer <br />or hereafter ac uired. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />200401663 <br />Nebraska Identification Number <br />Lien Filed With <br />Social Security Number <br />Spouse's Social Security Number <br />41980999 <br />❑X Register of Deeds <br />0 County Clerk <br />585 -49 -1392 <br />Amount of Tax <br />Lien Serial Number <br />Interest <br />Lien Type <br />Balance of <br />Date of Lien <br />County <br />032270888 <br />Original ❑ Continuation ❑ Corrected <br />02/17/2004 <br />Hall <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Sheila R Sanchez <br />Street Address <br />Street or Other Mailing Address <br />PO Box 184 <br />City <br />State Zip Code <br />City <br />State Zip Code <br />Grand Island <br />NE 68802 <br />Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />22 } -199-9 + 07101/2003 I 925.27 ! 65.55 I 401.07 I. I 1,391.89 <br />TOTAL $ 1,391.89 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the <br />determination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If, this Notice.of State <br />Tax Lien is n extension of an effective 'en, it serves to continue the priority of the state's interest in the affected property of the•taxpayer. ' <br />L'(� (I �. <br />TSS 308 385 -6067 <br />sign re arer's Signature Tifle Date. Telephone N tuber <br />here Revenue Supervisor / d. <br />Authoriz d g Title :' es. <br />4-94 -1974 Rev. 2 -2002 Supersedes 4.494 -1974 Rev. 10 -1995 <br />i <br />